Abstract
Background
Often ignored, hands are one of the most telltale signs of aging. This prospective study was initiated to evaluate the effect of subcutaneous hyaluronic acid (HA) injections in aging hands, with special attention to complications and long-term outcomes.
Methods
Between January 2010 and December 2010, a total of 38 patients with skin phototypes II–IV and between 58 and 76 years old were treated with HA injection for aging hands. The quantity of injection never exceeded 1.0–1.5 ml HA per hand. A clinical follow-up was performed at 2 weeks, 4 weeks, 3 months, and 6 months after injection. Complications were reviewed for the whole series. At the first follow-up, 2 weeks after the procedure, ultrasound was carried out to determine if additional filling material was required. At each follow-up, patients were asked to fill out a satisfaction questionnaire.
Results
Nine patients developed slight ecchymosis that disappeared after 1 week. No other complications were seen in the series. Pain during the injection and discomfort after the procedure were minimal. At the 2-week follow-up, after ultrasound control, nine patients received a complementary injection. At each follow-up, overall patient satisfaction was high and was validated by clearance of rhytids, veins, bony prominences, and dermal and subcutaneous atrophy.
Conclusion
Skin revitalization with injectable HA can improve the clinical appearance of the back of the hands. However, this therapy requires knowledge of the possible complications and their remediation as well as knowledge and respect of injected doses. Moreover, despite excellent results at each follow-up, the results of our series are not as good after 6 months, and a longer follow-up would be needed to determine if this procedure provides long-lasting benefit.
Level of Evidence III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Wu W, Carlisle I, Huang P, Ribé N, Russo R, Schaar C, Verpaele A, Strand A (2010) Novel administration technique for large-particle stabilized hyaluronic acid-based gel of nonanimal origin in facial tissue augmentation. Aesthetic Plast Surg 34:88–95
Lemperle G, Sadick NS, Knapp TR, Lemperle SM (2010) ArteFill permanent injectable for soft tissue augmentation: II. Indications and applications. Aesthetic Plast Surg 34:273–286
Kane MA (2005) Treatment of tear trough deformity and lower lid bowing with injectable hyaluronic acid. Aesthetic Plast Surg 29:363–367
Bergeret-Galley C, Latouche X, Illouz YG (2001) The value of a new filler material in corrective and cosmetic surgery: DermaLive and DermaDeep. Aesthetic Plast Surg 25:249–255
Olenius M (1998) The first clinical study using a new biodegradable implant for the treatment of lips, wrinkles, and folds. Aesthetic Plast Surg 22:97–101
Jakubietz RG, Jakubietz MG, Kloss D, Gruenert JG (2005) Defining the basic aesthetics of the hand. Aesthetic Plast Surg 29:546–551
Lemperle G, Morhenn V, Charrier U (2003) Human histology and persistence of various injectable filler substances for soft tissue augmentation. Aesthetic Plast Surg 27:354–366
Bains RD, Thorpe H, Southern S (2006) Hand aging: patients’ opinions. Plast Reconstr Surg 117:2212–2218
Butterwick KJ (2005) Rejuvenation of the aging hand. Dermatol Clin 23:512–527
Butterwick KJ (2002) Lipoaugmentation for aging hands: a comparison of the longevity and aesthetic results of centrifuged versus non centrifuged fat. Dermatol Surg 28:987–991
Butterwick KJ, Bevin AA, Iyer S (2006) Fat transplantation using fresh versus frozen fat: a side-by-side two-hand comparison pilot study. Dermatol Surg 32:642–644
Ellis IR, Schor SL (1996) Differential effects of TGFb1 on hyaluronan synthesis by fetal and adult skin fibroblasts: implications for cell migration and wound healing. Exp Cell Res 228:326–333
Chen WY, Abatangelo G (1999) Functions of hyaluronan in wound repair. Wound Repair Regen 7:79–89
Williams S, Tamburic S, Stensvik H, Weber M (2009) Changes in skin physiology and clinical appearance after microdroplet placement of hyaluronic acid in aging hands. J Cosmet Dermatol 8:216–225
Man J, Rao J, Goldman M (2008) A double bind comparative study of nonanimal-stabilized hyaluronic acid versus human collagen for tissue augmentation of the dorsal hands. Dermatol Surg 34:1026–1031
Coleman SR (2002) Hand rejuvenation with structural fat grafting. Plast Reconstr Surg 110:1731–1744
Adoubib JH, deCastro CC, Gradel J (1992) Hand rejuvenescence by fat filling. Ann Plast Surg 28:559–564
Matarasso SL, Carruthers JD, Jewell ML (2006) Restylane Consensus Group. Consensus recommendations for soft-tissue augmentation with nonanimal stabilized hyaluronic acid (Restylane). Plast Reconstr Surg 117:1–43
Kerscher M, Bayrhammer J, Reuther T (2008) Rejuvenating influence of a stabilized hyaluronic acid-based gel of nonanimal origin on facial skin aging. Dermatol Surg 34:720–726
Yoneda M, Yamagata M, Suzuki S, Kimata K (1988) Hyaluronic acid modulates proliferation of mouse dermal fibroblasts in culture. J Cell Sci 90:265–273
Wang F, Garza LA, Kang S et al (2007) In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol 143:155–163
Christensen L, Breiting V, Janssen M, Vuust J, Hogdall E (2005) Adverse reactions to injectable soft tissue permanent fillers. Aesthetic Plast Surg 29:34–48
Lowe NJ, Maxwell CA, Lowe P, Duick MG, Shah K (2001) Hyaluronic acid skin fillers. Adverse reactions and skin testing. J Am Acad Dermatol 45:930–933
Brody HJ (2005) Use of hyaluronidase in the treatment of granulomatous hyaluronic acid reactions. Dermatol Surg 31(8 Pt 1):893–897
Lupton JR, Alster TS (2000) Cutaneous hypersensitivity reaction to injectable hyaluronic acid gel. Dermatol Surg 26:135–137
De Boulle K (2004) Management of complications after implantation of fillers. J Cosmet Dermatol 3:2–15
Conflict of interest
The authors have no conflicts of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Leclère, F.M.P., Vögelin, E., Mordon, S. et al. Nonanimal Stabilized Hyaluronic Acid for Tissue Augmentation of the Dorsal Hands: A Prospective Study on 38 Patients. Aesth Plast Surg 36, 1367–1375 (2012). https://doi.org/10.1007/s00266-012-9974-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-012-9974-2